Employers Say Pharmacy Benefit Manager Contracts too Complex, Opaque

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Three in five employers think their contracts with pharmacy benefit managers are overly complex and not transparent, according to a new study. The study, which found that employers would prefer that PBMs are more transparent with their pricing and would like them to focus less on rebates and value-based designs, comes as PBMs are under increased scrutiny for their opaque pricing practices. The survey of 88 very large employers, “Toward Better Value: Employer Perspectives on What’s Wrong with the Management of Prescription Drug Benefits and How to Fix It,” was conducted by Benfield and commission by the National Pharmaceutical Council….
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Protect Yourself from Unexpectedly High Retirement Health Care Costs

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More than 40% of retirees encounter health care costs that are greater than they had anticipated or planned for. That’s according to a new study from the LIMRA Secure Retirement Institute. Here are LIMRA’s key findings: • Retirees spend 13% of their income on health and long-term care expenses, on average. • 43% of those with retirement plans still underestimate health care expenses in their golden years. Furthermore, seniors should plan for continued increases in health care costs, over and above the effects of inflation. According to HealthView Services’ 2017 Retirement Health Care Costs Data Report, health care costs are…
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Senate Works to Save CSR Payments, but Too Late for 2018

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The Affordable Care Act requires insurers to reduce cost sharing (deductibles and copays) in silver-level plans for marketplace enrollees with incomes below 250% of the federal poverty line. Until now, insurers have relied on offsetting payments from the federal government to provide this feature. These payments amounted to $7 billion for fiscal year 2017, $10 billion for 2018 and will reach $16 billion by 2027. However, the Trump administration in August moved to end the controversial set of payments to the insurance industry designed to encourage carriers to remain in the ACA exchanges. These payments – known as “cost-sharing reduction…
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After IRS Tweak Be Careful that You’re Complying with Affordability Test

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Now that the final attempt (this year) at dismantling the Affordable Care Act came to a quiet end in the last week of September, employers need make sure that they stay on track with compliance. First and foremost is that the ACA’s employer mandate and shared responsibility provisions still stand. That includes the affordability test, to which employers need to pay special attention, as increases in premium can put some of your employees over the edge into “unaffordable” coverage territory. And this year there’s a twist that you need to be aware of. As it’s almost time for open enrollment,…
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Breaking News: POTUS Signs Executive Order on Healthcare

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This morning, President Trump signed an Executive Order intended to improve access, increase choices and lower costs for healthcare. Below is a brief summary of what we know so far. Directs the Labor Secretary to consider regulations/guidance – within 60 days – expanding Association Health Plans, for the purpose of allowing employers in the same line of business anywhere in the country to join together in offering healthcare coverage to their employees. This potentially allows employers to form AHPs through existing organizations, or create new ones for the express purpose of offering group insurance. This could lead to the sale…
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How Many Seniors Get Medicare Open Enrollment Wrong

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Medicare can be hard to navigate, even if you’ve been enrolled for years. As open enrollment approaches – it starts Oct. 15 and runs through Dec. 7 – you’ll want to pay attention to some of the most common mistakes people make. Not understanding the difference between Original Medicare and Medicare Advantage – With Original Medicare, there is typically no premium for Part A coverage if you or your spouse paid Medicaid taxes while you were working. However, you do pay monthly premium for Part B coverage. Also, with Original Medicare, you can usually see any doctor or specialist you…
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Employers Seek New Ways to Reduce Health Insurance Inflation

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As employers anticipate that their employee health insurance costs will rise 5.5% for the 2018 policy year, they are also planning to step up their cost management efforts in new areas, according to a new study. And despite the maelstrom in Washington over how to deal with the Affordable Care Act, 92% of employers surveyed said they are “very confident” their organization will continue to sponsor health benefits in five years, according to the “Willis Towers Watson 2017 Health Care Employer Survey.” Employers will try to contain costs by exploring new strategies like emerging health care delivery systems, and arrangements…
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Trump Administration Writing Regs to Loosen Rules on Health Plan Tax Credits for Small Employers

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The Trump administration is crafting regulations that will allow small employers to bypass government-run exchanges to purchase coverage and still be eligible for a tax subsidy. Part of the Affordable Care Act provides for small employers to be eligible for a tax credit if they purchase health insurance for their workers on federally operated exchanges for small businesses. However, the Small Business Health Care Tax Credit is only available to employers that bought coverage on the Small Business Health Options Program (SHOP), leaving those who bought plans on the private market out of luck. Now the Centers for Medicare & Medicaid…
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IRS Proposes New Rules Making Health Coverage Opt-out Arrangements More Difficult

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The IRS has proposed new regulations that add another layer of complication to any employer that offers or is considering offering the option of cash in lieu of payment to employees that decline employer-sponsored health coverage. Already, any employer offering to pay employees who decline coverage has to walk a fine line and clearly state that the cash in lieu of payment is not to be used to purchase coverage elsewhere. As a result of these newly proposed rules, employers that are still offering cash in lieu of coverage may want to reconsider doing so because if they make a…
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